Provider Demographics
NPI:1790148997
Name:THE THERAPY TREE
Entity Type:Organization
Organization Name:THE THERAPY TREE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:KAYE
Authorized Official - Last Name:WALL
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:580-317-9140
Mailing Address - Street 1:3519 E JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:HUGO
Mailing Address - State:OK
Mailing Address - Zip Code:74743-4042
Mailing Address - Country:US
Mailing Address - Phone:580-317-9140
Mailing Address - Fax:580-317-9141
Practice Address - Street 1:3519 E JACKSON ST
Practice Address - Street 2:
Practice Address - City:HUGO
Practice Address - State:OK
Practice Address - Zip Code:74743-4042
Practice Address - Country:US
Practice Address - Phone:580-317-9140
Practice Address - Fax:580-317-9141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-04
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3499101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty